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施春明,赵博文,潘美,彭晓慧,王蓓,汪贤臣,沈丽君.超声心动图评估右心功能不全患者下腔静脉直径及塌陷指数[J].中国医学影像技术,2024,40(7):1015~1019

超声心动图评估右心功能不全患者下腔静脉直径及塌陷指数

Echocardiography for evaluating diameter and collapsibility index of inferior vena cava in patients with right heart dysfunction

投稿时间：2024-01-13 修订日期：2024-05-09

DOI：10.13929/j.issn.1003-3289.2024.07.012

中文关键词: 心房腔静脉,下超声心动描记术前瞻性研究

英文关键词:heart atria vena cava, inferior echocardiography prospective studies

基金项目:

作者	单位	E-mail
施春明	浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所, 浙江杭州 310016 萧山区第一人民医院超声科, 浙江杭州 311201
赵博文	浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所, 浙江杭州 310016	zbwcjp@zju.edu.cn
潘美	浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所, 浙江杭州 310016
彭晓慧	浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所, 浙江杭州 310016
王蓓	浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所, 浙江杭州 310016
汪贤臣	浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所, 浙江杭州 310016
沈丽君	萧山区第一人民医院超声科, 浙江杭州 311201

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中文摘要:

目的观察超声心动图测量右心功能不全患者下腔静脉(IVC)直径及评估塌陷指数(IVCCI)的观察者间一致性及其与右心参数的相关性。方法前瞻性以47例右心功能不全患者为观察组、50名右心功能正常者为对照组。以超声心动图测量右心室面积变化分数(FAC)、三尖瓣环收缩期位移(TAPSE)、右心室心肌做功指数(MPI),以及三尖瓣环收缩期运动速度(S')及舒张早、晚期运动速度(e'、a')并计算二者比值(e'/a'),测量三尖瓣口舒张早、晚期血流速度(E、A)并计算二者比值(E/A)及E/e',测量三尖瓣反流颈宽(TR-VCW)、三尖瓣最大反流速度(TR-V_max)、肺动脉收缩压(PASP)及右心房面积(RAA);分别采用二维(2D)超声和解剖M型超声测量呼吸周期中IVC管径最大值和最小值(IVCD_max、IVCD_min),并计算IVCCI;于2组分别随机抽取20人,采集IVC参数。比较组间基本资料、右心参数及IVC参数,计算后者观察者间组内相关系数(ICC),评估IVC参数与右心参数的相关性。结果组间性别、年龄及体质量指数(BMI)差异均无统计学意义(P均＞0.05)。相比对照组,观察组右心参数MPI、e'、e'/a'、E、A、E/e'、TR-VCW、TR-V_max、PASP及RAA升高而FAC、TAPSE、S'及a'降低(P均＜0.05)。2D超声与解剖M型超声所测观察组IVCD_max、IVCCI(ICC=0.787~0.971)及对照组IVCD_max(ICC=0.971、0.964)的观察者间一致性均良好,而对照组IVCCI的观察者间一致性均较差(ICC=0.169、0.456)。相比对照组,观察组IVC参数2D-IVCD_max、2D-IVCD_min、M-IVCD_max及M-IVCD_min均升高,而2D-IVCCI及M-IVCCI均降低(P均＜0.05)。2D-IVCD_max与右心参数TAPSE及a'呈弱负相关(r=－0.392、－0.364),与e'/a'、E、E/A、TR-VCW及RAA呈弱正相关(r=0.396、0.483、0.461、0.565、0.582);2D-IVCCI与右心参数TR-VCW及RAA呈弱负相关(r=－0.386、－0.380)。M-IVCD_max与右心参数TAPSE呈弱负相关(r=－0.384),与e'/a'、E、E/A、TR-VCW及RAA呈弱正相关(r=0.357、0.453、0.473、0.549、0.550),M-IVCCI与右心参数MPI、E、TR-VCW及RAA呈弱负相关(r=－0.347、－0.337、－0.475、－0.421)。结论以超声心动图测量右心功能不全患者IVC直径并评估IVCCI的观察者间一致性良好;2D超声及解剖M型超声所测IVC参数均与右心参数存在相关性。

英文摘要:

Objective To observe the inter-observer consistency of diameter of inferior vena cava (IVC) and IVC collapsibility index (IVCCI) measured and assessed with echocardiography and the correlations with right heart parameters in patients with right heart dysfunction. Methods Forty-seven patients with right heart dysfunction were prospectively recruited in observation group, while 50 adults with normal right heart function were taken as controls (control group). Parameters of the right heart were obtained with echocardiography, including the right ventricular fractional area change (FAC), the tricuspid annular plane systolic excursion (TAPSE), the myocardial performance index (MPI), the tricuspid annular systolic velocity (S') as well as early and late diastolic velocity (e', a') and e'/a' ratio, also the tricuspid valve orifice early and late diastolic velocities (E, A) and E/A ratio and E/e', the vena contracta width of tricuspid regurgitation (TR-VCW), the maximum velocity of tricuspid regurgitation (TR-V_max), the pulmonary artery systolic pressure (PASP) and right atrial area (RAA). Besides, the maximal and minimal diameter of IVC (IVCD_max, IVCD_min) during the respiratory cycle were measured with two dimensional (2D) ultrasound and anatomical M-mode ultrasound, respectively, and the IVCCI were calculated. Then 20 subjects were randomly selected from each group, and IVC parameters were obtained. The basic data, right heart parameters and IVC parameters were compared between groups, intra-class correlation coefficient (ICC) between 2 sonographers of IVC parameters were calculated, and correlations between IVC parameters and right heart parameters were assessed. Results No significant differences of gender, age nor body mass index (BMI) was detected between groups (all P＞0.05). Compared with those in control group, MPI, e', e'/a', E, A, E/e', TR-VCW, TR-V_max, PASP and RAA increased, whereas FAC, TAPSE, S' and a' decreased in observation group (all P＜0.05). The inter-observer consistencies were good for IVCD_max and IVCCI in observation group (ICC=0.787—0.971) and IVCD_max in the control group (ICC=0.971, 0.964) obtained with 2D ultrasound and anatomical M-mode ultrasound, but poor for IVCCI in control group (ICC=0.169, 0.456). Compared with those in control group, IVC parameters 2D-IVCD_max, 2D-IVCD_min, M-IVCD_max and M-IVCD_min increased but 2D-IVCCI and M-IVCCI decreased in observation group (all P＜0.05). In control group, 2D-IVCD_max was weakly negatively correlated with TAPSE and a' (r=－0.392, －0.364), weakly positively correlated with e'/a', E, E/A, TR-VCW and RAA (r=0.396, 0.483, 0.461, 0.565, 0.582), 2D-IVCCI was weakly negatively correlated with TR-VCW and RAA (r=－0.386, －0.380), while M-IVCD_max was weakly negatively correlated with TAPSE (r=－0.384), and weakly positively correlated with e'/a', E, E/A, TR-VCW and RAA (r=0.357, 0.453, 0.473, 0.549, 0.550), M-IVCCI was weakly negatively correlated with MPI, E, TR-VCW and RAA (r=－0.347, －0.337, －0.475, －0.421). Conclusion In patients with right heart dysfunction, IVCD diameter and IVCCI obtained with echocardiography had good inter-observer consistencies. Parameters obtained with 2D ultrasound and anatomic M-mode ultrasound had certain relations with the right heart parameters.

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